Aguero-Torres Hedda, Kivipelto Miia, von Strauss Eva
Aging Research Center (ARC), Karolinska Institutet, Stockholm, Sweden.
Dement Geriatr Cogn Disord. 2006;22(3):244-9. doi: 10.1159/000094973. Epub 2006 Aug 10.
To explore the hypothesis that older adults often are affected by more than one disease, making the differential diagnosis between Alzheimer's disease (AD) and vascular dementia (VaD) difficult.
Incident dementia cases (n = 308) from a population-based longitudinal study of people 75+ years were investigated. The DSM-III-R criteria were used for the clinical diagnosis of dementia. Data on vascular disorders (hypertension, cerebrovascular and ischemic heart diseases, heart failure, atrial fibrillation, diabetes) as well as type of onset/course of dementia were used retrospectively to reclassify dementias.
Only 47% of the AD cases were reclassified as pure AD without any vascular disorder. Among subjects with AD and with a vascular component, cerebrovascular disease was the most common (41%). Only 25% of VaD were reclassified as pure VaD. Further, 26% of the pure AD subjects developed a vascular disorder in the following 3 years.
Both vascular and degenerative mechanisms may often contribute to the expression of dementia among the elderly. Most of the AD cases have vascular involvements, and pure dementia types in very old subjects constitute only a minority of dementia cases.
探讨这样一种假说，即老年人常受不止一种疾病影响，这使得阿尔茨海默病（AD）与血管性痴呆（VaD）之间的鉴别诊断变得困难。
对来自一项针对75岁及以上人群的基于人群的纵向研究中的新发痴呆病例（n = 308）进行调查。采用《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）标准对痴呆进行临床诊断。回顾性地使用血管疾病（高血压、脑血管疾病和缺血性心脏病、心力衰竭、心房颤动、糖尿病）数据以及痴呆的起病/病程类型对痴呆进行重新分类。
只有47%的AD病例被重新分类为无任何血管疾病的单纯AD。在患有AD且有血管因素的受试者中，脑血管疾病最为常见（41%）。只有25%的VaD被重新分类为单纯VaD。此外，26%的单纯AD受试者在接下来的3年中出现了血管疾病。
血管机制和退行性机制通常都可能导致老年人痴呆的表现。大多数AD病例都有血管受累情况，而高龄受试者中的单纯痴呆类型仅占痴呆病例的少数。
